| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
7,809 |
2,814 |
$1.81M |
| L3216 |
Orthoped ladies shoes dpth i |
4,096 |
1,531 |
$166K |
| L3221 |
Orthopedic mens shoes dpth i |
2,537 |
923 |
$121K |
| L3030 |
Foot arch support remov prem |
768 |
322 |
$49K |
| A5500 |
Diab shoe for density insert |
558 |
367 |
$15K |
| T4522 |
Adult size brief/diaper med |
97 |
92 |
$10K |
| A5512 |
Multi den insert direct form |
285 |
186 |
$7K |
| T4523 |
Adult size brief/diaper lg |
25 |
24 |
$4K |
| T4535 |
Disposable liner/shield/pad |
52 |
48 |
$2K |
| T4524 |
Adult size brief/diaper xl |
13 |
13 |
$2K |